Australia ‘losing the war’ against drug-resistant infection, despite drop in use of antibiotics

A national report has found COVID caused one of the biggest drops in antibiotic use in Australia in decades, but fears remain the country is “losing the war” against drug-resistant infection.

While the Australian Commission on Safety and Quality in Health Care’s report found community antibiotic use had fallen 19 per cent since 2019, the country was one of the highest users in the world.

It said the biggest issues were adverse side effects from antibiotics, as well as the rise of several dangerous bacteria that are becoming increasingly resistant to antibiotic treatment, making it more difficult to treat serious infections. 

Antimicrobial resistance occurs when a microorganism develops  resistance to an antimicrobial that was previously an effective treatment. 

Hundreds of people in Australia die each year as a result.

COVID saw drop in prescriptions

The report found 21.8 million prescriptions for antimicrobials were dispensed in the community in 2022, compared with 26.6 million in 2017. 

Senior medical advisor for the commission, John Turnidge AO, said the pandemic had a powerful impact.

“COVID had a profound effect on the amount of antibiotics that we were using more than any other intervention we’ve done in the last 20 years,” Professor Turnidge said.

“People were locked down or they weren’t going to their doctor, they also weren’t getting viral infections so they weren’t going to the doctor and getting antibiotics inappropriately.”

Antibiotic use bouncing back

However, the report noted a 10 per cent uptick in antimicrobial use in the community in 2022.

In that year, one-in-three Australians were given at least one round of antibiotics.

The report noted many of the issues in prescribing antimicrobials were in hospital settings, with 23 per cent of prescriptions in hospitals deemed inappropriate.

It also found 80 per cent of acute bronchitis cases in the community were given antibiotics, despite no evidence of benefit and 35 per cent of scripts given in aged care settings were “precautionary”.

Professor Turnidge said Australia had a window of opportunity to continue to build on the downward trend which happened during COVID.

“Historically, there has been a lot of antibiotics use for respiratory infections, and 99 per cent are caused by viruses,” Professor Turnidge said.

“It’s that uncertainty about diagnosis that has driven this for the last 50 years really, and it takes quite a long time to convince people ‘you don’t need antibiotics if you have a virus’.

“Nobody asked for antibiotics when they got COVID, so maybe we can apply that to flu and coughs and colds and sore throats as well.”

Common pathogens such as Staphylococcus aureus, Escherichia coli, and Neisseria gonorrhoeae are highlighted in the report as becoming increasingly resistant to major drugs.

The report said Australia ranked seventh behind European countries, the United Kingdom and Canada in antimicrobial use in the community.

Queensland, New South Wales and Victoria highest use

Based on PBS data from 2022, the report found antimicrobial use was highest in Queensland, New South Wales and Victoria.

But lower rates of antimicrobial use were seen in 2020 and 2021 compared to previous years across all states and territories.

President of the Australian Medical Association (NSW) Dr Michael Bonning, said antibiotics had been seen as a “panacea”, but represented a “race against time for us as humans”.

“Most patients underestimate the affects of drug-resistant infections, thinking there is always another drug in the toolkit to save them and that toolkit is becoming more and more bare over time.”

Report findings 

• Community antibiotic use fell 18 per cent since 2019
• One in three Australians had at least one round of antibiotics in 2022
• 23 per cent of hospital setting prescriptions in 2022 were inappropriate
• 80 per cent of community acute bronchitis cases given antibiotics despite no benefit
• 35 per cent of script in aged care were precautionary

For individuals, he said avoiding antibiotics came down to hygiene practices and resting when ill.

“We wash our hands, we think about how long we store out food for, we are mindful of expiry dates,” he said.

“Take time off, get downtime so that you can heal up faster … not continuing to spread things around.

“You may not ask for antibiotics, but someone else might go to a doctor to get antibiotics for something that is otherwise viral.”

He said education was essential.

“As a community, we want to give GPs some support, we want the government to have national advertising and discussion about when antibiotics are appropriate, so it’s not just the GP holding back the tide of individuals who might be concerned and want antibiotics,” Dr Bonning said.

“Everyone needs some backup, and that is the one we need the most help on.

“Your immune system is the thing we need to support at the right time to ensure you get better.”

Professor Turnidge said probiotics were not as powerful as believed in helping return good bacteria to the body. 

“The way to think about it is antibiotics will damage your good bugs,” he said.

“Running around trying to replace it with yoghurt won’t be enough.

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